Provider Demographics
NPI:1306401088
Name:DURAN-BEDIAMOL, ALICE R (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:R
Last Name:DURAN-BEDIAMOL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 KAIOLA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8915
Mailing Address - Country:US
Mailing Address - Phone:916-591-4201
Mailing Address - Fax:
Practice Address - Street 1:180 ALANUI KEALII DR
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8585
Practice Address - Country:US
Practice Address - Phone:916-591-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI88053163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool